Nutrition impact symptoms in head and neck cancer during radiotherapy: a longitudinal study

Abstract

Background

Patients with head and neck cancer (HNC) receiving radiotherapy (RT) are at a high risk of weight loss (WL) due to a variety of nutrition impact symptoms (NISs).

Objective

This prospective observational study aimed to investigate the consecutive changes of NIS during RT and analyzed its impact on body weight.

Materials and methods

The Head and Neck patient Symptom Checklist was adopted to evaluate NIS. NIS, body weight, hemoglobin and lymphocyte of 94 participants were assessed at four time points during RT and the treatment outcomes were assessed at the time of 12 months after the completion of RT. Generalised estimation equations (GEEs) and Kendall’s tau-b were used for statistical analysis.

Results

Our study found that pain, taste changes and dry mouth were the most common NIS, reported by >90% of patients and had higher interference scores (more than 85% >2) at the end of RT. The average WL was 4.22 ± 3.59 kg after treatment, and more than two-thirds of patients (67.02%, 64/94) experienced significant WL of >5%. Lack of energy, vomiting and taste changes impacted WL significantly (p < .05). Taste changes were also associated with hemoglobin and lymphocyte reduction (p = .018, p < .001). WL correlated negatively with tumor response (p = .031).

Conclusions and significance

In patients with HNC, taste changes, pain, dry mouth and vomiting were seen. Nutritional intervention applied as early as the first 10 days of RT could help to change the nutrition status and improve the clinical outcomes.

Chinese Abstract

背景：由于多种营养影响症状 (Nis), 接受放疗 (Rt) 的头颈癌 (hNc) 患者体重减轻 (Wl) 的风险很高。

目的：本前瞻性观察研究旨在调查放疗 期间营养影响症状 的连续变化, 并分析其对体重的影响。

材料与方法：采用头颈部患者症状检查表对营养影响症状进行检测。 在放疗期间的四个时间点评估 94 名参与者的营养影响症状、体重、血红蛋白和淋巴细胞, 并在放疗完成后 12 个月时评估治疗结果。 广义估计方程 (Gees) 和 Kendall 的 tau-b 用于统计分析。

结果：我们的研究发现, 疼痛、味觉改变和口干是最常见的 营养影响症状, 超过90% 的患者报告了这些, 并且在放疗结束时有更高的干扰评分（超过 85% >2）。 治疗后平均体重指数为 4.22 ± 3.59 千克, 超过三分之二的患者 (67.02%, 64/94) 经历了显著体重减少（>5%）。 乏力、呕吐和味觉变化显著影响体重减轻 (p < .05)。 味觉变化也与血红蛋白和淋巴细胞减少有关 (p = .018, p < .001)。 体重减轻与肿瘤反应负相关 (p = .031)。

结论与意义：头颈癌患者表现出味觉改变、疼痛、口干、呕吐。 早在放疗的前 10 天就进行营养干预可以帮助改变营养状况并改善临床结果。

Keywords:

• Nutrition impact symptoms
• malnutrition
• head and neck cancer
• radiotherapy
• tumor response

Acknowledgements

The authors thank all participating investigators.

Author contributions

Minmin Li and Ting Liu conceived and designed the study. Tao Zhang, Qitao Gou and Ting Liu acquired and provided the data. Minmin Li and Ting Liu analyzed the data. Minmin Li wrote the manuscript. Chris Nutting and Ting Liu reviewed the manuscript. All authors have read and approved the final version of this paper.

Ethical approval

The present study was approved by the Ethical and Scientific Committees of The First Affiliated Hospital of Chongqing Medical University.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

Data are available on request from the authors.

Additional information

Funding

This study was supported by the Youth Project Applied Technology Research Foundation of Chongqing Education Commission, Grant/Award Number: KJQN202100407.